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Annex 2 Example of An Alert Level System US FINAL
Annex 2 Example of An Alert Level System US FINAL
Below is an example of an alert-level system with indicators and thresholds for USA States
ICU availability of
Do we have capacity to treat Meet threshold Meet threshold over
surge beds above 40% or more 30-39% 20-29% Less than 20%
severe cases? over a 3-day period 3-day period
Health care current capacity
system
Are we protecting health care Number of health care Increasing over a Decreasing over a Increasing or
No HCW infections Decreasing Decreasing
workers? worker infections 7-day period 7-day period unknown
Percentage of tests Increasing over a Decreasing over a
< 5% 5-9% 10-14% 15% or higher
that are positive 7-day period 7-day period
Are we testing enough to detect
cases? Total testing per 1,000 Meet threshold Meet threshold over <1.5 per 1000 average
Disease >10 5-10 1.5-5
people per day over a 7-day period a 7-day period per day
control
Percentage of
Do we have robust contact Meet threshold Meet threshold over
new cases from 50% or more 30-49% 10-29% <10%
tracing? over a 7-day period a 7-day period
quarantined contacts
* Jurisdictions may decrease the overall level by one increment, and one increment only, if there is an openly made societal decision that the economic and/or social harms from the restrictions outweigh
the benefits on control of Covid-19. In this case, it is especially important to ensure widespread adherence to physical distancing and safety practices. Before increasing a level, the potential impact on
economic and social harms should also be considered.
** In the absence of reliable data on new cases, daily trends in new hospitalizations and/or deaths should be monitored.
*** Consider the heterogeneity and population density of the setting when determining risk level. If an isolated confined outbreak or rural area (e.g. population <50 per square mile), this generally has lower
transmission risk than a distributed pattern throughout community or a dense area.
Annex 2: Example of an alert-level system and supporting communication tools – U.S.
This is version 1.0. We’re making significant revisions and will release version 2.0 soon. Updated June 1, 2020.
• Stay at home
• High burden • Limited capacity to safely care • Schools closed (e-learning)
for cases Limited or no ability • No mass gatherings
Level 4
• Increasing spread to isolate cases and • Essential services only
High Risk • Many health care worker quarantine contacts • Modified health care services (e.g. telemedicine)
• Many outbreaks infections • No non-essential visits to congregate facilities (e.g. nursing homes)
• Recreation locally with safety measures** (e.g. walking)
* At all levels, individuals should wash hands, cover coughs, wear a mask in public as indicated, stay home if sick, maintain physical distancing, keep surfaces clean. Vulnerable people 60 and older or those with underlying conditions or
immunocompromised should minimize travel outside the home
** Safety measures include appropriate measures to reduce transmission such as: Reducing occupancy, staggering shifts, working remotely, physical distancing, separating customers from employees, reducing public transportation use,
screening employees, working in lower transmission geographic areas, reducing risk to vulnerable groups, keeping places clean with routine cleaning and disinfection, providing necessary supplies and equipment (e.g. sanitizer).
Annex 2: Example of an alert-level system and supporting communication tools – U.S.
This is version 1.0. We’re making significant revisions and will release version 2.0 soon. Updated June 1, 2020.
Alert Level 4
Widespread outbreak that is growing with Level 4 undetected cases.
Take strong measures
• Only essential services should be open
• Travel should be severely limited
many undetected cases. Very High Risk to limit all contact.
Very High Risk Take strong measures to limit all contact.
Many cases including • General public should reduce non-essential travel
Alert Level 2
Moderate number of cases with most cases Alert cases with most cases
from a known source.
safely, should wear a mask in public
• Large public gatherings should have enhanced safety
from a known source.
Moderate Risk Increase efforts to limit personal exposure.
Level 2 Increase efforts features
Moderate Risk to limit personal • High-risk individuals should limit public travel and
exposure. take precautions
Cases are rare and contact tracing can be used
Alert Level 1 to control the virus. Alert Cases are rare and
contact tracing can be • All individuals should practice personal infection
New normal Take everyday precautions. Level 1 used to control the virus.
Take everyday
control: Wash hands, cover coughs, keep surfaces clean
• Wear mask if ill and stay home if sick
New normal precautions.
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Annex 2: Example of an alert-level system and supporting communication tools – U.S.
This is version 1.0. We’re making significant revisions and will release version 2.0 soon. Updated June 1, 2020.
1. Changes to alert level and implementation of measures should be advised by a multisectoral advisory group.
2. Allow at least two weeks after reducing the alert level before further reducing it to allow for a proper communications and engagement strategy to be developed,
and note that it may take 3-12 weeks or more for the epidemiologic impact of reduced physical distancing to become apparent in new COVID-19 illness.
3. Prepare in advance for appropriate response measures so they can be implemented rapidly.
2. Your results should be alert levels for each category, for example:
Health care
Annex 2: Example of an alert-level system and supporting communication tools – U.S.
This is version 1.0. We’re making significant revisions and will release version 2.0 soon. Updated June 1, 2020.
1. After determining the current alert level, you need to monitor data to identify whether
you have met any of the triggers for raising or lowering the level
o This means you must have a dashboard or some other way to monitor data on a daily
basis.
o One example of the type of data you should monitor is here:
https://www.covidexitstrategy.org/
o Once a trigger is met and information verified, then level for the indicator should be
changed.
For example, for the ICU availability with surge indicator
If the ICUs in your jurisdiction have had 32% availability (including surge
capacity) over the past 3 days, then the current level is yellow (level 2)
Alert level
If the ICU availability drops to 24% over a 3-day period, then your ICU 3
capacity indicator is now orange (level 3)
o You should update the indicator level, category indicator level and overall alert system
level based on this change.
* Jurisdictions may decrease the overall level by one increment, and one increment only, if there is an openly made societal decision that the economic and/or social harms from the restrictions outweigh the benefits on control of
Covid-19. In this case, it is especially important to ensure widespread adherence to physical distancing and safety practices. Before increasing a level and implementing measures, the potential impact on economic and social harms
should also be considered.
** In the absence of reliable data on new cases, daily trends in new hospitalizations and/or deaths should be monitored.
*** Consider the heterogeneity and population density of the setting when determining risk level. If an isolated confined outbreak or rural area (e.g. population<50 per square mile), this generally has lower transmission risk than if a
distributed pattern throughout community or a dense area.
Annex 2: Example of an alert-level system and supporting communication tools – U.S.
This is version 1.0. We’re making significant revisions and will release version 2.0 soon. Updated June 1, 2020.
Health care
Recommended measures
• Stay at home
• High burden • Limited capacity to safely care • Schools closed (e-learning)
for cases Limited or no ability • No mass gatherings
Level 4
• Increasing spread to isolate cases and • Essential services only
High Risk • Many health care worker quarantine contacts • Modified health care services (e.g. telemedicine)
• Many outbreaks infections • No non-essential visits to congregate facilities (e.g. nursing homes)
• Recreation locally with safety measures** (e.g. walking)
* At all levels, individuals should wash hands, cover coughs, wear a mask in public as indicated, stay home if sick, maintain physical distancing, keep surfaces clean. Vulnerable people 60 and older or those with underlying conditions or immunocompromised should
minimize travel outside the home.
** Safety measures include appropriate measures to reduce transmission such as: Reducing occupancy, staggering shifts, working remotely, physical distancing, separating customers from employees, reducing public transportation use, screening employees, working in
lower transmission geographic areas, reducing risk to vulnerable groups, keeping places clean with routine cleaning and disinfection, providing necessary supplies and equipment (e.g. sanitizer).